Clinical significance of centripetal propagation of vasoconstriction in patients with reversible cerebral vasoconstriction syndrome: A retrospective case-control study

Abstract

Introduction We previously reported centripetal propagation of vasoconstriction at the time of thunderclap headache remission in patients with reversible cerebral vasoconstriction syndrome. Here we examine the clinical significance of centripetal propagation of vasoconstriction. Methods Participants comprised 48 patients who underwent magnetic resonance angiography within 72 h of reversible cerebral vasoconstriction syndrome onset and within 48 h of thunderclap headache remission. Results In 24 of the 48 patients (50%), centripetal propagation of vasoconstriction occurred on magnetic resonance angiography at the time of thunderclap headache remission. The interval from first to last thunderclap headache in patients with centripetal propagation of vasoconstriction (14 ± 10 days) was significantly longer than that of patients without centripetal propagation of vasoconstriction (4 ± 2 days). In the patients with centripetal propagation of vasoconstriction at the time of thunderclap headache remission, the incidence of another cerebral lesion (38%, 9 of 24 cases) was significantly higher than in patients without centripetal propagation of vasoconstriction (0%). From findings of sequential magnetic resonance angiography before and after thunderclap headache remission, we observed tendencies in which centripetal propagation of vasoconstriction gradually progressed after the onset of reversible cerebral vasoconstriction syndrome and peaked at the time of thunderclap headache remission. The progress of centripetal propagation of vasoconstriction concluded with thunderclap headache remission. Conclusions Centripetal propagation of vasoconstriction has clinical significance as an indicator of the severity of reversible cerebral vasoconstriction syndrome. The presence of centripetal propagation of vasoconstriction is associated with an increased risk of brain lesions and a longer interval from first to last thunderclap headache. Moreover, repeat magnetic resonance angiography to assess centripetal propagation of vasoconstriction during the time from onset to thunderclap headache remission can help diagnose reversible cerebral vasoconstriction syndrome.

Quantitative arterial spin labeling magnetic resonance imaging analysis of reversible cerebral vasoconstriction syndrome: A case series

“…Patient backgrounds were standardized by applying the following inclusion criteria: (i) clinical diagnosis of RCVS according to the International Classification of Headache Disorders, 3rd edition 4 and (ii) serial ASL and MRA acquisition from symptom onset to 3 months or later. The onset of RCVS was defined as the first episode of thunderclap headache, defined as a severe pain that peaks rapidly within seconds, and it was diagnosed by interviewing the patient thoroughly 5 . Patients who did not undergo ASL or MRA were excluded.…”

“…The onset of RCVS was defined as the first episode of thunderclap headache, defined as a severe pain that peaks rapidly within seconds, and it was diagnosed by interviewing the patient thoroughly. 5 Patients who did not undergo ASL or MRA were excluded. Digital subtraction angiography was not performed in any patient.…”

Thunderclap headache and reversible cerebral vasoconstriction syndrome: Current theory and accumulated data

“…42 Asian patients appear to have more idiopathic but benign RCVS. 18,46,48 However, it is not clear whether Asian patients have a greater risk of mild RCVS, even in the absence of a causative condition, or whether they are more resistant to the complications of RCVS. 48…”

“…Calcium channel blockers, including nimodipine, have been administered to patients with RCVS via oral and intravenous routes and have been shown in prospective and retrospective studies to provide symptomatic relief, including relieving headache. Since nimodipine has not been released in Japan, oral lomerizine and verapamil are used as empiric therapies. Glucocorticoids, which have been administered to patients with RCVS without improvement in either patient symptoms or sequelae of the disease, have been accused of worsening the clinical course .…”

“…In a large Taiwanese study, recurrent RCVS occurred in 5.4% of patients during a mean period of approximately 3 ± 2 years, with a delay from the first to the second bout ranging from 6 months to 7 years; as such, RCVS is not necessarily monophasic . Asian patients appear to have more idiopathic but benign RCVS . However, it is not clear whether Asian patients have a greater risk of mild RCVS, even in the absence of a causative condition, or whether they are more resistant to the complications of RCVS …”